Provider Demographics
NPI:1699815241
Name:W A JONES OPTICAL CO., INC.
Entity Type:Organization
Organization Name:W A JONES OPTICAL CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-887-9267
Mailing Address - Street 1:4715 GREAT NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3428
Mailing Address - Country:US
Mailing Address - Phone:440-887-9267
Mailing Address - Fax:
Practice Address - Street 1:4715 GREAT NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3428
Practice Address - Country:US
Practice Address - Phone:440-887-9267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4470380Medicaid
OH141951OtherEYE MED
OH141667OtherEYEMED
OH141684OtherEYE MED
OH141492OtherEYEMED
OH141743OtherEYE MED
0452400005Medicare ID - Type Unspecified
OH4470380Medicaid